AB0824 THE ROLE OF IMMUNOSUPPRESSIVE THERAPY IN GASTROINTESTINAL INVOLVEMENT AND ITS IMPACT ON QUALITY OF LIFE IN PATIENTS WITH SYSTEMIC SCLEROSIS - A COHORT STUDY
Authors: I. Genrinho, T. Santiago, A. Carones Esteves, A. Barcelos, C. Mazeda, I. Santos, M. Couto, F. Campos Costa, T. Beirão, G. Terroso, M. Rato, P. Ferreira, P. Monteiro
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Gastrointestinal (GI) disease is a major cause of morbimortality in systemic sclerosis (SSc) and affects up to 90% of patients. GI manifestations are frequently unrecognized in early phases and there are few data suggesting the potential effect of immunosuppression (IS) in GI tract. <h3>Objectives</h3> The aim of this study was to evaluate the role of IS in GI involvement and its impact on health-related quality of life (HRQoL) in SSc patients. <h3>Methods</h3> A cross-sectional multicenter study was conducted, enrolling SSc patients that fulfilled the 2013ACR/EULAR criteria or presented the EUSTAR criteria for very early diagnosis of SSc (VEDOSS). Patients were requested to answer UCLA Scleroderma Clinical Trial Consortium Gastrointestinal Tract, SHAQ and Short Form Health Survey (SF36) measures. Social-demographic and clinical data were collected. GI involvement was determined by the presence of one of the following: GI symptoms for at least 3 of the last 7 days, abnormalities in GI exams and/or use of GI pharmacological therapies. IS was defined as exposure to at least one of the following: mycophenolate mofetil (MMF), cyclophosphamide (CYC), methotrexate (MTX), azathioprine (AZA), leflunomide, glucocorticoids (&gt;10mg/d prednisone-equivalent), rituximab, tocilizumab, and abatacept, for more than 6 months. General descriptive analysis and independent parametric or non-parametric tests were performed using SPSSv26. <h3>Results</h3> One-hundred and one patients were included, 83 female (82.2%), with a mean age of 56.8±12.39 years-old and a mean duration of disease of 67.2±72.5 months. Sixty-four patients (63.4%) had limited SSc, 30 (29.7%) diffuse and 7 (6.9%) presented VEDOSS. Forty patients were under IS therapy, being the MTX the most frequent drug in 21.8%, followed by MMF in 11.9% and AZA in 5.9%. Seventy-two patients (71.3%) had GI involvement, where clinical manifestations were present in 72.2% patients, abnormalities in GI exams in 44.4% and GI pharmacotherapy was used in 41.7% patients. Patients with GI involvement were significantly more frequent under IS therapy (p=0.044), although no differences were found in severity of symptoms in UCLA domains between patients with and without IS. On the other hand, patients without GI involvement and under IS therapy presented significantly higher total UCLA score (mean 0.10±0.11 vs 0.11±0.18 for patients with and without IS therapy respectively, p=0.046). IS group was significantly more frequent under GI pharmacotherapy (p=0.006), being the proton pump inhibitors (PPI) the most significantly prescribed drug (55% vs 16.4% for patients with and without IS respectively, p&lt;0.01). IS group had significantly higher SHAQ scores in total item (p=0.001) and overall disease severity VAS (p=0.009). Regarding HRQoL patients under IS present significantly lower SF36 scores for physical functioning (p=0.001), physical role functioning (p=0.002), physical component summary (p=0.001) and general health perception (p=0.036). <h3>Conclusion</h3> Patients with GI involvement were more frequent under IS, although no differences were found in severity of symptoms in UCLA domains when compared to those without IS. IS therapy was associated with worst HRQoL probably due to more severe multi-organ disease and were treated more often with PPI. Investigation is needed to evaluate the potential effects of IS in GI tract, as patients with absence of GI involvement presented higher UCLA scores when IS therapy was given, which may reflect the potential GI complaints as an adverse effect by therapy, rather than involvement by the SSc. <h3>References</h3> [1]Khanna D et al. Arthritis Rheum, 2009; 61: 1257-63 [2]Thoua N, et al. Assessment of gastrointestinal symptoms in patients with systemic sclerosis in a UK tertiary referral centre, Rheumatology 2010;49:1770–1775 [3]McFarlane I. et al, Gastrointestinal Manifestations of Systemic Sclerosis, McFarlane et al., Rheumatology (Sunnyvale) 2018 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.